The number of nationally endorsed and locally developed guidelines has grown considerably. However, guideline use for daily patient care remains largely underutilized. Despite the increased promotion and installation of clinical information systems, computerized guideline implementation efforts continue to encounter numerous barriers. One of the most common barriers is the clinician's requirement to remember actively to initiate the guideline and carry out time-sensitive assessments that guide patient care. However, without clinicians initiating the process the effects of computerized guideline implementation efforts on clinical care remain limited. The goal of this project is to examine the impact of a new, sustainable informatics approach for implementing clinical guidelines through the application of an integrated information technology infrastructure. The approach is based on two components: 1) a disease detection system, and 2) a disease management system. The disease detection system includes a probabilistic, computerized, real-time mechanism that automatically identifies guideline eligible patients and reminds clinicians to initiate and apply the guideline process. The disease management system includes a team-oriented, workflow-integrated, computerized guideline implementation, which repeatedly reminds clinicians about pending guideline tasks during the patient encounter. Using the recently updated pediatric asthma guideline from the National Heart, Lung, and Blood Institute as an example, the project will examine the feasibility and effect of the new approach in the challenging environment of a busy pediatric emergency department. The following aims will be achieved: Aim 1: Implement a real-time, computerized asthma detection system and integrate the system with the emergency department information system. Aim 2: Examine the effect of the asthma detection system on reminding clinicians to use the paper-based asthma guideline in a prospective evaluation. Aim 3: Implement and integrate the asthma disease management system in the emergency department information system infrastructure. Aim 4: Examine the effect of the asthma detection system combined with the management system compared to the asthma detection system combined with the paper-based guideline in a prospective study.